12A RUSSELL DR - BUILDING INSPECTION (4) CITY OF-Swnpm
PUBLIC PROPERTY
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APPLICATION FOR THE REPAIR. RENOVATION, CQH j jBJLc Q y
D LM(M OR CHANGR OF USE OR OCCUP, NCY, FOR ANY ZZRT rNG
STRUCTURE OR BLULDING
1.0 SITE INFORMATION.
Locedan Names:
Pi"W I►Is kxabd Ina;Conswallon Mee YIN Hk+tarls Dk wd YM_A[_
2.0 OWNERSHIP INFORMATION
11 Owner of Laved
Names Z77 rz-5 �
Address'
Telephone:
0A COMPLETE THIS SECTION FOR WORK IN EUSMNQ BUILDINt3s ONLY
Addition Existing
Renovation Number of Stories Renovated
pChan" in Use New
on
nate year of Area par Raw(sf) Renovated
tion or renovation
g building New
scription of Proposed Work:
--- -- ---Mail Permit to: - - -
What is the eurremt use of the BU Wkq? M dweNGq,now msny omits?
Material of 13uetdrg7
iry ins ffuiidne0 Ca+f^ Chimney
Asbptos9
W
b-The i►L m ey Guys
/ntdtbds Hants
Address and PhO W 978 M A n i ncn
978-977-9900
Machwiles Name
Address and Phorw HIC Rs0lstration 0
Co wiuc*m &**visors t.loeme tl
Eatlmated Cost of Projaat d 98 l� Perm Fes glMdOM
Parma Fee i Estimated Cat X$71$1000 Residential
_- - Endmated Coax:111:1000Cammwcwt--- -
eye Addnkxu 1 S.00 in added ss an
Admkftku vs ahsnys.
Make sure that all flekla are property and k+pibly written to avoid delays in PrconsU+O.
The undersigrwd dos hereby apply far a Suildkq Pemdt to build to the above stated
sped0adwie, SWwd under penally of PWJwy
Date
3 � �
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